Cost considerations of medical therapy for glaucoma

PURPOSE: To determine the calculated daily patient cost (cost minimization) of medical glaucoma therapy. METHODS: The actual volume of various glaucoma medications was determined f or all commercially available sizes of the tested products. The drops per m l on the basis of the actual volume and the daily costs of the dosage sched ules recommended by the manufacturers were compared. The cost of each bottl e of medication was determined from the average wholesale price in the Unit ed States. RESULTS: The generic timolol products dosed twice daily and the once-daily gel-forming solutions (range, $0.30 to $0.46/day) were similar on a cost-pe r-day basis compared with the brand name metipranolol (Optipranolol; Bausch & Lomb Pharmaceuticals, Tampa, Florida, at $0.43/day) and timolol (Timopti c; Merck, West Point, Pennsylvania, at $0.46/day and Timoptic XE at $0.38/d ay). Betaxolol (Betoptic S; Alcon Laboratories, Fort Worth, Texas, at $0.65 /day), carteolol (Ocupress; CibaVision, Duluth, Georgia, at $0.57/day), lev obunolol ($0.61/day), and brand name levobunolol (Betagan; Allergan, Irvine , California, at $0.81/day) all were dosed twice daily and were more costly on a per day basis. The topical carbonic anhydrase inhibitors brinzolamide (Azopt; Alcon, at $0.96/day) and dorzolamide (Trusopt; Merck, at $1.02/day ) were dosed three times daily and were similar on a cost-per-day basis. Th e combination product Cosopt (timolol 0.5% + dorzolamide 2.0%, Merck, at $1 .12/day) was less costly than separate bottles of a topical carbonic anhydr ase inhibitor (three times daily dosing) and a beta-blocker ($1.26 to $1.83 /day), often even if the topical carbonic anhydrase inhibitor was dosed two times daily ($0.94 to $1.49). The selective alpha(2)-agonist brimonidine ( Alphagan; Allergan, at $0.90/day) twice daily and the prostaglandin analog latanoprost (Xalatan; Pharmacia & Upjohn, Kalamazoo, Michigan, at $0.92/day ) once daily were similarly priced. CONCLUSIONS: All generic timolol, Optipranolol, Timoptic, and Timoptic XE r anged between $0.30 and $0.46 per day. Betaxolol, Ocupress, generic levobun olol, and Betagan were more costly, ranging between $0.57 and $0.81 per day . Cosopt ($1.12/day) was less costly than separate bottles of a topical bet a-blocker and a topical carbonic anhydrase inhibitor dosed three times dail y ($1.26 to $1.83/day) and often twice daily ($0.94 to $1.49). Alphagan and Xalatan were similarly priced ($0.90/day and $0.92/day, respectively). Thi s study is based on a best-case scenario for all medicines and does not acc ount for wasted doses, the frequency of refills, or a medication's success or failure rate. New adjunctive glaucoma regimens exhibit similar costs per day compared with more traditional regimens. (Am J Ophthalmol 1999;128:426 -433. (C) 1999 by Elsevier Science Inc. All rights reserved.).